VERSION 004010X098A1 - Magellan Provider's Home Page

Magellan Behavioral Health 837 Professional Companion GuideREFRendering Provider SecondaryIdentificationPos: 271 Max: 5Detail - OptionalLoop: 2310B Elements: 0Magellan Specific Note:Provider Primary Id:Magellan will accept a National Provider Identifier (NPI) and its associated qualifier (NM109 using an ‘XX’ qualifier), butMagellan is requiring a dual usage of an NPI as the primary identifier with a federal tax ID (TIN) (REF02 using an ‘EI’qualifier) and/or a social security number (SSN) (REF02 using an ‘SY’ qualifier) in their respective secondary identifierREF segments for the following provider loops:• 2010AA Billing Provider• 2010AB Pay-To Provider• 2310B Rendering Provider• 2420A Rendering ProviderIf an NPI is used for the above provider types without a TIN (REF02 using an ‘EI’ qualifier) and/or SSN (REF02 using an‘SY’ qualifier) for a secondary identifier, claim will be rejected in a 997 or 277U.To comply with HIPAA regulations, Magellan will require NPI usage for provider primary identifiers after May 22, 2008.MIS# will no longer be accepted after this date.Secondary Ids2010AA REF-02; 2010AB REF-02; 2310B REF-02; 2420A REF-02 should be sent as outlined in the rules noted below:• In REF-01 use qualifier "G2" Commercial Identifier to report the MIS# and "SY" SSN to report the Social SecurityNumber.• The Magellan Provider Identifier (MIS#) is required for TennCare. (This is for PO Boxes 12700, 12400)• Roster providers for TennCare also require a Social Security Number along with the MIS#. (This is for PO Boxes12700, 12400)• All other accounts: The Magellan Provider Identifier (MIS#) is requested for all providers. Use qualifier "G2"Commercial Number to report the MIS#.• In the future, the MIS# will be required for all non-Medicaid claims.Magellan Specific Note:If more than one Rendering Provider (based on Primary ID match) is submitted on a claim, the claim will not load to thehost adjudication system and a negative response will be returned.Rendering Provider is required on TennCare Caserate claims.MIS# will no longer be accepted after May 22, 2008._________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (004010X098A1) Version 7 36